HHS Implements Strategy To Stop Overmedicalization With Psychiatric Medications
Updated
HHS is implementing a strategy and framework to reduce the overprescription of psychiatric medications. The administrators of four HHS agencies penned a Dear Colleague letter encouraging health care providers to provide full, informed consent for medications while prioritizing non-pharmacological methods as the first line of defense.
“HHS encourages clinicians and provider organizations to support a treatment approach grounded in shared decision-making, patient autonomy, and fully informed consent,” the administrators wrote. “Individuals should receive clear, understandable information regarding the potential benefits and risks of psychiatric medications at initiation, during ongoing treatment, and when discontinuation is being considered. That discussion should include the purpose of the medication, expected benefits, possible adverse effects, monitoring needs, potential discontinuation symptoms, the risks of abrupt cessation when relevant, the possibility of relapse or recurrence, and the availability of evidence-based non-pharmacological interventions.”
The administrators described several medical billing pathways where providers can be reimbursed for providing non-pharmacological treatment options to patients. The administrators encourage providers to use these options when appropriate, on a case-by-case basis. These options include diet modification, nutritional therapy, psychotherapy, and family-based interventions. They emphasize nutrition, psychotherapy, and family-based services as an important part of a “comprehensive, person-centered behavioral health care” approach.
CDC data from 2020 shows that 20.3% of adults received mental health treatment. 16.5% took prescription medication for their mental health, and 10.1% received counseling or therapy from a mental health professional. One out of five American adults received mental health treatment, and only about half of them received counseling, even though 81% of them received medication.
Alongside this announcement, the MAHA Institute held a Mental Health and Overmedicalization Summit with HHS Secretary Robert F. Kennedy Jr., researchers, clinicians, and former medicalized patients to discuss problems associated with psychiatric medications.
“Millions of our young people now grow up convinced something is wrong with them,” said Laura Delano, an author and consultant who was medicalized on antidepressants as a teenager and stayed on the medications for 14 years. “They’ve been taught to take their despair and self-doubt and loneliness, their shame and obsession and alienation, their struggles in friendship and romance, their fear and angst and grief, and translate all of these experiences into symptoms of incurable brain pathology requiring lifelong pharmaceutical use. They’ve grown convinced, like I once was, that their life’s main purpose is symptom management with endless pills, therapy, and programs. They are convinced the only way the depth of their pain can be seen, understood, and validated is through medicalizing it.”
Surveys show that as much as 30-50% of antidepressant users have no evidence-based indication to continue. During the summit, several patients described serious side effects they experienced as a result of antidepressant medications from sexual dysfunction to permanent brain damage.
One speaker, identified as Dani, said she was prescribed at the age of seven after her parents were referred to a doctor for the treatment of ADHD. She said she was diagnosed with a learning disability, but the medication itself caused her to have the very learning disability it was supposed to be correcting.
“Adverse side effects were interpreted as new diagnosis, and more drugs were prescribed to treat the problems that the medications themselves had caused,” Dani said. “This spiraled into a prescription cascade of anti-depressants, benzodiazepines, mood stabilizers, and antipsychotics, all before my 10th birthday. None of it ever felt right. But I was a child, and I didn’t have the words to explain what was happening. And I didn’t have the authority to challenge it. My completely normal childhood behavior was pathologized. I wasn’t in crisis. I wasn’t struggling or acting out. I was simply a fidgety, shy, sensitive little girl who didn’t fit the mold of how a child was supposed to behave in a classroom setting.”
The administrators in the Dear Colleague letter explained that deprescribing is appropriate in multiple scenarios, including at times when the psychiatric medications are causing burdensome side effects or the treatment is not providing a meaningful benefit. The administrators also say patients can be tapered off from medication if the treatment goals have been met or the patient’s informed preferences call for a carefully monitored taper. The administrators note that deprescribing is done on an individualized basis and is not the same as “abrupt discontinuation or blanket medication reduction.”
A 2019 review explains that “most depressed patients treated with antidepressants experience fewer than the required diagnostic number (five of nine for 2 or more weeks) of Major Depressive Disorder symptoms.” The author adds that antidepressant drugs for these patients have marginal benefits from the medication, at best. The paper states that this is among the top four drugs that are overprescribed alongside opioids for the treatment of chronic pain.
The HighWire reported in March about a pervasive issue that has existed for decades involving the use of antipsychotic medications for dementia patients in nursing homes. While the practice has been a known issue, nursing homes have started falsely diagnosing patients with schizophrenia to justify the use of antipsychotics.
A 2021 review concluded that mothers with postpartum depression are being overprescribed antidepressants, especially in certain geographical locations, despite no evidence of benefit. Furthermore, the authors note that studies showing a benefit for mothers with postpartum depression contain small or underrepresented samples.